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KMID : 0948920120110020078
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Clinical Pain
2012 Volume.11 No. 2 p.78 ~ p.83
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Decompressive Epidural Neuroplasty
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Choi Eun-Seok
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Abstract
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Chronic low back pain has a prevalence ranging from 35% to 75% at 12 months after the initial attack and is a challenging problem to both physiatrists and patients. On the basis of the advances of modern imaging technology, discovery of chemical mediators, reported success of minimally invasive spine procedures, and the unique training program of physical medicine & rehabilitation, spine intervention becomes a fast-growing field of practice for physiatrists. Post lumbar laminectomy syndrome, vascular compromise, spinal stenosis, and inflammatory response have been implicated in chronic low back pain. Post operative epidural fibrosis may contribute from 5% to 60% of poor surgical outcome following decompressive surgery. Although some reported a correlation between peridural scarring and radicular pain, and poor clinical outcomes, others have questioned the role of epidural fibrosis as a cause of chronic pain. Decompressive epidural neuroplasty is an interventional pain management technique that has been introduced to remove epidural scar which results in direct or indirect compression, inflammation, edema, and diminishing nutrients to spinal nerve roots. According to recent researches, there is moderate to strong evidence to indicate effectiveness of decompressive epidural neuroplasty with administration of epidural steroids in chronic, refractory low back pain and radicular pain of post lumbar laminectomy syndrome or epidural fibrosis, such as significant pain relief, functional improvement, improvement of psychologic status, and return to work
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KEYWORD
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Low back pain, Percutaneous adhesiolysis, Post lumbar laminectomy syndrome, Epidural fibrosis
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